Prolactin response to electroconvulsive therapy: effects of electrode placement and stimulus dosage.
BACKGROUND
It is unclear whether the serum prolactin (PRL) surge following electroconvulsive therapy (ECT) is a marker of optimal ECT administration. We investigated the relations among PRL surge, stimulus parameters, and outcome in major depressive disorder (MDD).


METHODS
Seventy-nine patients with MDD were randomized in a double-blind trial to right unilateral (RUL) or bilateral (BL), and to low-dose (just above seizure threshold) or high-dose (2.5 x threshold) ECT.


RESULTS
Change in PRL (delta PRL) varied among treatment groups, with significant effects of electrode placement (BL > RUL, p < .006), electrical dosage (high > low, p < .04), and gender (female > male, p < .005). There was no evidence that clinical improvement was associated with greater PRL surge.


CONCLUSIONS
Although delta PRL varied with parameters impacting on response rates, these data indicate the PRL surge cannot serve as a useful index of clinically effective treatment. This finding does not support the view that diencephalic seizure propagation is necessary for ECT to exert therapeutic effects.
Lisanby
S H
SH
Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA.
Devanand
D P
DP
Prudic
J
J
Pierson
D
D
Nobler
M S
MS
Fitzsimons
L
L
Sackeim
H A
HA
D000328:Adult; D003071:Cognition; D003866:Depressive Disorder / Q000097:blood* / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D011388:Prolactin / Q000097:blood*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D011388:Prolactin